title: Inner nuclear layer thickening is inversley proportional to retinal ganglion cell loss in optic neuritis.
abstract: OBJECTIVE
  To examine the relationship between retinal ganglion cell loss and changes in the inner nuclear layer (INL) in optic neuritis (ON).
  
  
  METHODS
  36 multiple sclerosis (MS) patients with a history of ON and 36 age and sex-matched controls underwent Optical Coherence Tomography. The paramacular retinal nerve fiber layer (RNFL), combined ganglion cell and inner plexiform layers (GCL/IPL) and inner nuclear layer (INL) thickness were measured at 36 points around the fovea. To remove inter-subject variability, the difference in thickness of each layer between the ON and fellow eye of each patient was calculated. A topographic analysis was conducted.
  
  
  RESULTS
  The INL of the ON patients was thicker than the controls (42.9µm versus 39.6µm, p=0.002). ON patients also had a thinner RNFL (27.8µm versus 32.2µm, p<0.001) and GCL/IPL (69.3µm versus 98.1µm, p<0.001). Among the controls, there was no correlation between RNFL and GCL/IPL as well as RNFL and INL, but a positive correlation was seen between GCL/IPL and INL (r=0.65, p<0.001). In the ON group, there was a positive correlation between RNFL and GCL/IPL (r=0.80, p<0.001) but a negative correlation between RNFL and INL (r=-0.61, p<0.001) as well as GCL/IPL and INL (r=-0.44, p=0.007). The negative correlation between GCL/IPL and INL strengthened in the ON group when inter-subject variability was removed (r=-0.75, p<0.001). Microcysts within the INL were present in 5 ON patients, mainly in the superior and infero-nasal paramacular regions. While patients with microcysts lay at the far end of the correlation curve between GCL/IPL and INL (i.e. larger INL and smaller GCL/IPL compared to other patients), their exclusion did not affect the correlation (r= -0.76, p<0.001).
  
  
  CONCLUSIONS
  INL enlargement in MS-related ON is associated with the severity of GCL loss. This is a continuous relationship and patients with INL microcysts may represent the extreme end of the scale.
authors.affiliation: Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Megha
authors.initials: M
authors.lastname: Kaushik
authors.forename: Chen Yu
authors.initials: CY
authors.lastname: Wang
authors.forename: Michael H
authors.initials: MH
authors.lastname: Barnett
authors.forename: Raymond
authors.initials: R
authors.lastname: Garrick
authors.forename: John
authors.initials: J
authors.lastname: Parratt
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Graham
authors.forename: Prema
authors.initials: P
authors.lastname: Sriram
authors.forename: Con
authors.initials: C
authors.lastname: Yiannikas
authors.forename: Alexandr
authors.initials: A
authors.lastname: Klistorner
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002452:Cell Count; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D009902:Optic Neuritis / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D055351:Retinal Neurons / Q000473:pathology*; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence